Open-door Laminoplasty Group Research Articles

Two-level Anterior Cervical Corpectomy and Fusion versus Posterior Open-door Laminoplasty for the Treatment of Cervical Ossification of Posterior Longitudinal Ligament: A Comparison of the Clinical Impact on the Occipito-Atlantoaxial Complex.

Both two-level anterior cervical corpectomy and fusion (t-ACCF) and posterior open-door laminoplasty (ODLP) are effective surgical procedures for the treatment of ossification of the posterior longitudinal ligament (OPLL). Previous studies have identified different effects of different surgical procedures on the upper and subaxial cervical spine (UCS, SCS), however, there are no studies on the effects of t-ACCF and ODLP on the occipito-atlantoaxial complex. Therefore, the purpose of this study is to compare the changes in sagittal parameters and range of motion (ROM) of the occipito-atlantoaxial complex in OPLL patients treated with t-ACCF and ODLP. This was a retrospective study that included 74 patients who underwent t-ACCF or ODLP for the treatment of OPLL from January 2012 to August 2022 at our institution. Preoperative, 3-month, and 1-year postoperative cervical neutral, flexion-extension, and lateral flexion radiographs were taken. Sagittal parameters including Cobb angle of C2-7, C0-2, C0-1, C1-2, C2 slope, and the ROM were measured. The clinical outcome was assessed using the JOA, VAS, and NDI scores preoperatively and at 3 and 12 months postoperatively. Multiple linear regression was employed to identify factors influencing changes in UCS. In the ODLP group, the SCS (C2-7) Cobb angle was significantly reduced (12.85 ± 10.0 to 7.68 ± 11.27; p < 0.05), and the UCS (C0-2) Cobb angle was significantly compensated for at 1 year postoperatively compared with the t-ACCF group (3.05 ± 4.09 vs 0.79 ± 2.62; p < 0.01). The SCS and lateral flexion ROM of the ODLP group was better maintained than t-ACCF (14.51 ± 6.00 vs 10.72 ± 3.79; 6.87 ± 4.56 vs 3.81 ± 1.67; p < 0.01). The compensatory increase in C0-2, C0-1, and C1-2 ROM was pronounced in both groups, especially in the ODLP group. The results of multiple linear regression showed that only the surgical procedure was a significant factor influencing UCS. The loss of the SCS Cobb angle was more pronounced in ODLP relative to t-ACCF, resulting in a significant compensatory increase in UCS and atlantoaxial Cobb angle. The ROM of the UCS, atlantooccipital, and atlantoaxial joints was significantly increased in both groups, this may accelerate degenerative changes in the occipital-atlantoaxial complex, may leading to poorer outcomes in the long-term; of these, ODLP should receive more attention. In contrast, t-ACCF better maintains normal curvature of the SCS and occipito-atlantoaxial complex but loses more ROM.

Comparative Effectiveness and Functional Outcome of Open-Door versus French-Door Laminoplasty for Multilevel Cervical Myelopathy: A Meta-Analysis.

BACKGROUND:At present, few reports are comparing these 2 major cervical posterior laminoplasty methods with Open-door and French-door Laminoplasty in terms of neurological recovery, cervical alignment, and surgical complications. Moreover, most of the research has not been well designed.AIM:This study aims to determine comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy.METHODS:The Meta-analysis is used in this study. The study sample is a published research articles on comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy on the internet through databases on PubMed and ProQuest and published between 1997 until December 2018. Weighted mean difference and pooled weighted mean difference are calculated by using the fixed-effect model or random-effect model. Data is processed by using Review Manager 5.3 (RevMan 5.3).RESULTS:This study reviews 58 articles. There are 6 studies conducted a systematic review and continued with Meta-analysis of relevant data. The results showed significant higher postoperative Japanese Orthopaedic Association (JOA) score in open-door laminoplasty (ODL) than French-door laminoplasty (FDL) (weighted mean difference [WMD] = 0.71; 95% confidence interval [CI]: 0.35 to 1.07; p < 0.05). The outcome of procedures treatment of multilevel cervical myelopathy revealed the operative time, cervical range of motion, axial canal diameter postoperative, axial pain reduction and complications events in ODL and FDL there was no significant difference. But for a cervical lordotic angle in ODL and FDL, there was a significant difference; the ODL group were significantly lesser than the FDL group. The recovery rate in ODL and FDL, there was a significant difference; the ODL was shown to be significantly higher than FDL (p < 0.05).CONCLUSION:This analysis suggests that neither cervical laminoplasty approach is superior, based on the postoperative radiological data and complication rate. But the open-door laminoplasty resulted in a higher functional outcome and recovery rate as compared to the French-door laminoplasty.

Extensor muscle-preserving laminectomy in treating multilevel cervical spondylotic myelopathy compared with laminoplasty.

Laminectomy and laminoplasty are popularly used in posterior cervical spine surgery but still have involved complications. We aimed to compare the clinical outcomes of microscope-assisted extensor muscle-preserving laminectomy (MA-EMPL) and open-door laminoplasty (ODLP) in treating multilevel cervical spondylotic myelopathy (MCSM). A prospective study was designed to enroll twenty patients with MCSM underwent MA-EMPL, and recruit twenty-four patients with MCSM received ODLP (control). Radiographic measurements, outcome indicators including Japanese Orthopedic Association (JOA) score and visual analogue score (VAS) were used to evaluate technical effectiveness. Surgical complications were documented to assess technical safety. Postoperative cervical curvature index and range of neck motion (ROM) were not significantly changed except ROM in ODLP group. Postoperative JOA score and VAS in both groups showed improvements at final follow-up. There was no statistical difference in postoperative neurological recovery rates between two groups (67.6%±17.8% vs. 70.15%±19.6%, P=0.632). However, VAS was significantly lower at postoperative 1 month in MA-EMPL group compared with ODLP group (P<0.001). The incidences of C5 palsy were 0 vs. 16.7% between MA-EMPL group and ODLP group. There was no axial symptom occurred in MA-EMPL group while six patients in ODLP group (0 vs. 25%, P=0.049). In addition, the mean blood loss and hospital stay were lesser in MA-EMPL group compared with ODLP group (P<0.001, P=0.002, respectively). MA-EMPL is an effective, safe and minimally invasive method in treatment of MCSM. Compared with ODLP, MA-EMPL has advantage to decrease intraoperative blood loss, hospital stay, postoperative VAS and axial symptom, as well as preserve postoperative ROM.

Clinical effect of modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament com-plex in treating ossification of posterior longitudinal ligament of the cervical spine

Objective To investigate the clinical efficacy of modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament complex in treating ossification of posterior longitudinal ligament (OPLL) of the cervical spine. Methods From June 2015 to July 2017, thirty-two patients with OPLL of the cervical spine who underwent modified open-door laminoplasty with preservation of the unilateral paraspinal muscle ligament complex were retrospectively analyzed (modified group). There were 20 males and 12 females with the average age of 61.72±8.41 years (range 46-75 years). The de-compression segment range included three cases of C2-C6, seven cases of C2-C7, eight cases of C3-C6, and fourteen cases of C3-C7. Moreover, twenty-three patients with OPLL of the cervical spine who underwent traditional unilateral open-door laminoplas-ty at the same time were included as controls (control group). The demographics, operation duration, and blood loss volume was recorded. The visual analogue scale (VAS), Japanese Orthopaedic Association scores (JOA), improvement rate of JOA score and neck disability index (NDI) were recorded and analyzed at preoperation, three months after operation, six months af-ter operation and at the final follow-up. The cervical curvature, cervical curvature index (CCI), range of motion (ROM) were measured and statistically analyzed on the lateral X-ray film of the cervical spine. The union rate of the lamina hinge and that of spinous process-lamina was measured on the cross section of the CT scan. Bilateral cervical posterior muscle volume was re-corded and analyzed at cross-section plane on MRI. Axial symptoms, C5 nerve root palsy and other complications were also re-corded. Results All the patients were followed-up for 6 to 18 months (mean, 13.04±4.67 months in control group, 11.81±4.93 months in modified group). At the final follow-up, the JOA, VAS and NDI scores improved from preoperatively 6.09±0.79 to 13.43±1.53, 4.22±1.04 to 2.83±1.15 and 25.48%±3.20% to 8.83%±5.41% in the control group, versus 6.28±1.05 to 13.88±1.48, 4.09±1.00 to 1.16±0.57 and 25.06%±3.24% to 5.66%±2.46% in the modified group. The postoperative JOA score and recovery rate of the two groups was not significantly different, whereas the VAS and NDI scores were significantly reduced in the modified group compared to the control group. The maximum cervical flexion angle, cervical curvature, ROM and CCI of control group were 6.26°±3.31°, 30.17°±4.56°, 11.39°±1.95° and 9.74%±4.05% at the final follow-up, which were reduced significantly compared to pre-op-eration. The maximum cervical flexion angle, cervical curvature, ROM and CCI of modified group were 10.06°±1.93°, 35.03°±5.01°, 17.03°±2.86° and 14.22%±5.00%, and there were no significant differences compared to pre-operation. There were signifi-cant differences among two groups. At the final follow-up, the posterior muscle volume of the two groups at open side was de-creased compared to preoperation, but there was no significant difference between the two groups. At the last follow-up, the posteri-or muscle volume at hinge side was not changed compared to preoperation in modified open-door laminoplasty group, while the vol-ume of the posterior muscle at hinge side in the traditional control group decreased compared to preoperation. The difference was statistically significant. A total of eight patients with axial symptom were present after operation. There were two patients (6%, 2/32) in the modified group and six patients (26%, 6/23) in the control group. The difference of axial symptoms incidence was statisti-cally significant between the two groups. Conclusion Modified open-door laminoplasty with preservation of the unilateral para-spinal muscle ligament complex is an effective technique in treating OPLL of the cervical spine. The technique not only guaran-teed to have good recovery of neurological function and to maintain cervical curvature and range of motion, but also contributed to decrease the occurrence of postoperative axial symptoms. Key words: Cervical vertebrae; Ossification of posterior longitudinal ligament; Decompression, surgical

A clinical Study of C2 dome-like expansive laminoplasty and C2 expansive open-door laminoplastyinupper cervical ossifi-cation of the posterior longitudinal ligament

Objective To explore the clinical effects of C2 dome-like expansive laminoplasty and C2 expansive open-door laminoplasty in upper cervical(involve or above C2 segment) ossification of the posterior longitudinal ligament. Methods All of 39 patients (22 males and 17 females) withcervical ossification of the posterior longitudinal ligament up to C2 which causedcompression symptoms were operated with posterior cervical surgery in ourhospital from January 2013 to June 2017.The average age was 55.74+7.91 years old, ranging from 39 to 71 years. Among these patients, 21 patients underwent C2 dome-like expansive laminoplasty and 18 underwent C2 expansive open-door laminoplasty, the patients in both groups underwent the C3-C7 expansive open-door laminoplasty. The preoperative and postoperative Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) score, the xisual analog scale(VAS) and the space available for the spinal cord (SAC) of C2 segment in X-ray were measured and statistically analyzed. Results All patients were followed up, the follow-up time was from 15 to 63 months (mean 42.3±17.7 months). There was no significant difference in the general condition, NDI, JOA score and JOA score improvement rate between preoperative and postoperative follow-up in 2 groups. There were significant differences in the NDI, JOA, VAS and SAC between preoperative and postoperative follow-up in 2 groups. The VAS score in C2 dome-like expan-sive laminoplasty group 1.52±1.2 was significantly lower than that in C2 expansive open-door laminoplasty group 2.06±0.87(t=-2.23, P<0.05), while the SAC in C2 expansive open-door laminoplasty group 14.11±1.023 was significantly higher than that in C2 dome-like expansive laminoplasty group 11.86±1.014(t=-6.89, P<0.05). No failure of internal fixation or recurrent compres-sion was found during follow-up. Conclusion For patients with ossification of posterior longitudinal ligament up to C2 or higher level, both C2 dome-like expansive laminoplasty and C2 expansive open-door laminoplasty can achieve good results. The SAC in C2 expansive open-door laminoplastygroup was superior to that in C2 dome-like expansive laminoplasty group, while the postoperative pain was more obvious. There was no significant difference in postoperative neurological recovery between the two groups. Using C2 dome-like expansive laminoplasty could reduce postoperative axial pain than the C2 expansive open-door laminoplasty surgery. For patients withossified tissue in the spinal canal, which occupies more than 50% of the sagittal diameter of the spinal canal, or with developmental spinal stenosis, C2 expansive open-door laminoplasty may berecommend to get more adequate decompression. Key words: Cervical vertebrae; Ossification of posterior longitudinal ligament; Axis; Decompression, surgical

Laminoplasty versus multiple anterior cervical discectomy for cervical spondylotic myelopathy in patients with a lordotic cervical spine

BackgroundUsing anterior or posterior surgery for multilevel cervical spondylotic myelopathy continues to be a subject of considerable debate. Studies comparing the two approaches are limited and few studies focus on anterior cervical discectomy and fusion (ACDF) as against open-door laminoplasty (ODL).Study designThis investigation was designed as a prospective study.ObjectiveThe aim of the study was to compare the clinical outcomes, radiographic changes, and complications of patients with multilevel cervical spondylotic myelopathy who underwent ACDF and ODL in the lordotic cervical spine.Patients and methodsWe evaluated 40 patients (20 patients in the ACDF group and 20 patients in the ODL group) at our institution from September 2005 to December 2008. They were followed up for a minimum of 2 years. The clinical outcomes [Nurick grade and Japanese Orthopaedic Association (JOA) score], radiographic changes (radiograph and MRI), and complications were compared between the two groups.ResultsODL showed significantly longer operative time (155 vs. 95 min) and more blood loss (438 vs. 215 ml) compared with ACDF. Both the ACDF and ODL groups showed significant improvement in Nurick grade from 3.5 and 3.4 preoperatively to 1.85 and 1.95, respectively, at last follow-up (P<0.05). Both groups showed significant improvement in the JOA score (P<0.05), and recovery rate was similar (63.2% in the ACDF group and 64.4% in the ODL group) (P>0.05). Cervical motion (on dynamic lateral radiograph) decreased significantly postoperatively in both groups (P<0.05) but was seen to have significantly improved in the ODL group at last follow-up. Minimal complications were reported in both groups.ConclusionBoth ACDF and ODL are effective treatment modalities for multilevel cervical spondylotic myelopathy with no significant difference between the two groups in Nurick grade, JOA score, recovery rate, and MRI sagittal canal diameter widening. However, the ODL group showed significantly better cervical motion at last follow-up but, unfortunately, longer operative time and greater blood loss.

頚椎椎弓形成術における神経合併症について―片開き式ときょく突起縦割式の比較―

We investigated the incidence of postoperative complications in open-door laminoplasty (ODL) and French-window laminoplasty (FWL). This retrospective study consisted of 320 patients who were treated by ODL and 122 patients by FWL between 1987 and 2001. Postoperative transient paralysis of the nerve root occurred in five patients (1.5%) in the ODL group and 7 (5.7%) in the FWL group. While postoperative paralysis due to hematoma occurred in five patients (1.5%) in the ODL group, there were none in the FWL group. ODL and FWL share certain features of neurological complications. Treatment should therefore be selected recognizing these features.